Form Crr026 - Consent To A Criminal Record Check For Volunteers - British Columbia
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1
2CONSENT TO A CRIMINAL RECORD CHECK
FOR
VOLUNTEERS
(WORKING WITH CHILDREN AND/OR VULNERABLE ADULTS)
IMPORTANT: Please read information and instructions on Page 2. To avoid processing delays, ensure all
relevant fields are complete and the form is dated and signed.
WORKS WITH (choose one):
children
vulnerable adults
children and vulnerable adults
Please verify with your volunteer organization which "works with" category applies to you.
PART 1: APPLICANT INFORMATION
Legal Surname / Last name:
Legal Given / First Name:
Legal Middle Name:
Date of Birth:
Gender:
M
F
Birthplace:
YYYY
MM
DD
Additional Names (Alias, Maiden Name, etc.):
Surname / Last Name:
Given / First Name:
Middle Name:
Residential Address:
City:
Province:
Country:
Postal Code:
Mailing Address (If Different from above):
City:
Province:
Country:
Postal Code:
Contact Area Code & Phone No.
Driver's Licence #:
PART 2: VOLUNTEER ORGANIZATION INFORMATION
To be completed by an authorized organization representative
SECTION A Complete this section if you have been provided an ID number by the Criminal Records Review Program (CRRP).
Volunteer Organization Name:
Organization Contact Person Name and Title (the person to receive the result of the criminal record check):
ID Number
(Provided by the CRRP):
SECTION B If you are unable to provide an ID Number please complete ALL of Section B.
Volunteer Organization Name:
Organization Contact Name or Title
(The person receiving the result of the check):
Mailing Address:
City:
Province:
Country:
Postal Code:
Office Area Code & Phone No:
Organization E-Mail Address:
SECTION C
Volunteer's position/Job Title with volunteer organization:
CONSENT FOR RELEASE OF INFORMATION AND ACKNOWLEDGMENTS:
I have read and understand the consent for release of information and acknowledgments on Page 2.
I hereby consent to these terms as indicated by my signature below:
Applicant Signature
Date Signed
YYYY / MM / DD
Ministry of Public Safety and Solicitor General
Phone: toll-free 1-855-587-0185 (Option 2) Fax: 250-953-0408 Email: criminalrecords@gov.bc.ca
Criminal Records Review Program
Website:
Policing and Security Programs Branch, Security Programs Division
PO Box 9217 Stn Prov Govt, Victoria BC V8W 9J1
Page 1 of 2
CRR026 REV 30/SEP/2016
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Parent category: Legal